НАЦИОНАЛЬНАЯ ПРОГРАММА по профилактике и контролю сердечно-сосудистых заболеваний на 2014-2020 годы

Objectives

The National Programme for the Prevention and Control of Cardiovascular Diseases for 2014-2020 provides Moldova’s strategic framework for reducing cardiovascular morbidity and mortality, increasing life expectancy, and achieving a 10% reduction in cardiovascular mortality by 2020.[1][2]It responds to cardiovascular diseases being the leading cause of death, accounting for approximately 57.5% of deaths during the preceding decade.[3]

• Reduce cardiovascular risk and improve early detection through primary prevention for children, young people, healthy adults, older people without cardiovascular disease, and people at low individual risk.[2][4]
• Strengthen intersectoral risk reduction and secondary prevention for people at high cardiovascular risk and those with diagnosed disease, including healthier lifestyles, prevention of recurrence, fewer readmissions and lower mortality.[4]
• Modernise specialised diagnosis and treatment, including interventional cardiology, management of cardiac rhythm disorders, cardiovascular surgery for adults and children, and early revascularisation.[2][4][5][6]
• Establish cardiovascular rehabilitation across inpatient, outpatient and home settings, encompassing secondary and tertiary prevention and palliative care.[2][7]
• Reduce morbidity and disability by 10%, increase acceptance of combined treatment and prevention to 50%, expand mobile-device telemonitoring, and provide palliative care to 10% of patients with severe heart failure.[7]
• Improve postgraduate education, specialist workforce preparation and research in cardiology, cardiac surgery, interventional cardiology, electrophysiology, rehabilitation, preventive cardiology and palliative care.[2][8]
• Achieve additional expected outcomes including a 20% reduction in acute cardiovascular and cerebrovascular disease, a 30% increase in detection and registration of adult hypertension, blood-pressure treatment for 50% of patients, dyslipidaemia treatment coverage for 15% of adults, and a 20% reduction in disability after three years of continuous follow-up.[6]

Implementation

Implementation combines national stewardship with local delivery through a phased programme, service modernisation, prevention, workforce development, electronic monitoring and mandatory reporting. The Government approved the National Programme and its Action Plan; the Ministry of Health controls implementation, while participating ministries and other central administrative authorities carry out planned actions.[1][9]

• Implement the programme in two phases: conduct baseline analysis, develop local prevention and control programmes, introduce phased actions, financing measures and monitoring during 2014-2016; then deliver most measures locally during 2017-2020 using electronic health monitoring and information on risk-factor trends and prevention quality.[10]
• Develop territorial programmes aligned with the National Programme through the Chisinau and Balti municipal councils, the autonomous territorial unit of Gagauzia, and district councils.[1]
• Involve primary care, specialised services, district medical institutions, municipal hospitals and tertiary care in locally delivered prevention, diagnosis, treatment and rehabilitation.[10]
• Increase public knowledge of cardiovascular risk factors and prevention routes by 20% by 2020, and ensure that at least 80% of relevant medical staff have appropriate knowledge for primary prevention, early diagnosis and clinical care.[4][11]
• Apply the HeartScore individual-risk assessment chart for European countries with high cardiovascular risk among 80% to 100% of people registered with family doctors.[11]
• Expand annual screening for pre-clinical peripheral arterial atherosclerosis among adults at high cardiovascular risk to 100% coverage by 2020, and ensure early identification of congenital heart defects during antenatal, neonatal and first-year-of-life stages.[11]
• Establish coronary intensive-care units in all newly created regional hospitals by 2020, create a tertiary anticoagulation therapy centre, develop e-Health centres and expand public-private partnerships.[11]
• Develop minimally invasive interventional cardiology, including treatment of acute myocardial infarction through percutaneous coronary angioplasty, and introduce national electrophysiological diagnosis by 2015.[5]
• Expand transcatheter ablation and implantation of cardiac electrical devices, strengthen the technical base and surgical access for adult cardiovascular surgery, and reduce delays for patients awaiting cardiac surgery.[5][6]
• Update cardiology curricula in accordance with international guidance and European Society of Cardiology recommendations; train family doctors, specialists and nursing staff in e-Health and telemonitoring; and establish postgraduate preparation and specialised teams for palliative care.[8]
• Develop fundamental, applied and registry-based research supported by information systems for paediatric and adult cardiology and cardiac surgery.[8]
• Monitor implementation through the Action Plan, electronic local monitoring, and mandatory registries of diagnostic and treatment methods and trends in morbidity, disability and mortality.[10][12]
• Require heads of public healthcare institutions to ensure data accuracy and submit annual results to the Ministry of Health by 15 March; require participating ministries and central administrative authorities to report annually by 15 March, followed by Ministry of Health reporting to the Government by 15 April.[9][12]
• Prepare a final report on the effectiveness of planned actions and programme implementation by the end of 2020.[12]

Monitoring & Evaluation

The programme combines outcome, service-coverage, quality and risk-factor indicators with annual institutional reporting, local electronic monitoring and a final effectiveness review. Its principal outcome target is to reduce cardiovascular mortality by 10% by 2020.[2][6]

• Measure implementation through targets including a 20% increase in public knowledge of cardiovascular risk factors and prevention by 2020; relevant knowledge among at least 80% of health staff involved in prevention, diagnosis and care; HeartScore-based individual risk assessment for 80% to 100% of people registered with family doctors; and annual screening for pre-clinical peripheral arterial atherosclerosis among 100% of adults at high cardiovascular risk by 2020.[4][11]
• Track expected health-service and population results, including a 20% reduction in acute cardiovascular and cerebrovascular disease, a 30% increase in detection and registration of adult hypertension, blood-pressure treatment for 50% of patients, dyslipidaemia treatment coverage among 15% of adults, and a 20% reduction in disability after three years of continuous follow-up.[6]
• Monitor progress against specific objectives and review preliminary implementation results by the end of 2016.[10]
• Use local electronic monitoring to follow health parameters, population and vulnerable-group risk-factor trends, and the quality of primary and secondary prevention.[10]
• Maintain mandatory registries on modern diagnostic and treatment methods and on morbidity, disability and mortality trends to enable objective effectiveness assessment.[10]
• Assess awareness of health indicators and risk-reduction measures among adults and children, screening coverage among eligible groups, and the frequency and prevalence of eight cardiovascular risk factors among people aged 3-18 and 19-65 years.[13]
• Apply reference values covering tobacco use, physical activity, fruit and vegetable intake, systolic blood pressure, total and low-density lipoprotein cholesterol, obesity and diabetes.[13]
• Develop effectiveness and quality-control criteria for cardiovascular diagnosis and treatment.[5]
• Monitor indicator areas spanning cardiovascular risk assessment; hypertension and dyslipidaemia; diagnostic equipment and biomarker testing; adherence to national and institutional protocols; registry participation; remote monitoring; specialist interventions; electrophysiology; cardiac surgery; rehabilitation; secondary-prevention medicines; compensated medicines; and local palliative care.[14][15]
• Follow Chapter VII indicators through the Action Plan for implementing the National Programme for the Prevention and Control of Cardiovascular Diseases for 2014-2020.[12]
• Require heads of public healthcare institutions to ensure the accuracy of assessment indicators and submitted data, and submit annual results to the Ministry of Health by 15 March.[12]
• Require participating ministries and other central administrative authorities to report annual implementation measures to the Ministry of Health by 15 March, and require the Ministry of Health to report to the Government by 15 April.[9]
• Assign control of execution of the Government decision to the Ministry of Health and prepare a final report on the effectiveness of planned actions and programme implementation by the end of 2020.[9][12]

The supplied material does not specify detailed evaluation methods, indicator definitions, data-validation procedures, surveillance governance, publication arrangements or sanctions for non-compliance.[3][16][2][4][11][5]

Costing & Financing

Financing for the 2014-2020 National Programme is to be provided within the national public or state budget and from other financial sources permitted under applicable legislation.[9][10]

• Provide preliminary implementation expenditure in an annex to the National Programme.[10]
• Support compensated medicines through compulsory health-insurance funds for chronic cardiovascular disease and risk-factor management, although no monetary allocation is provided.[15]
• Recognise substantial service needs, including an estimated 1,500-2,000 revascularisation operations annually for ischaemic heart disease and approximately 1,500 patients who could potentially leave the disability register after surgery each year.[17][18]

The supplied excerpts do not provide the programme budget, annexed expenditure amounts, activity-level costs, allocations by institution or intervention, expenditure data, funding gaps, resource-mobilisation plan, financing shares or economic assumptions.[16][2][4][11][5][10][15]